| NPI | 1447234620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-460) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA460-3) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2012-01-25 |